Full Name
*
Phone Number
*
Email Address
*
Address
*
City, State, Zip
*
Do you consume high amounts of polyunsaturated vegetable oils?
*
Have you been diagnosed with insulin resistance?
*
Do you have diabetes or hypoglycemia?
*
Are you significantly overweight?
*
Have you taken Statin drugs at any time in the last 2 years?
*
Do you presently have elevated cholesterol above 220 total?
*
Are your HDL and LDL levels significantly out of ratio?
*
Do you have skin tags (small painless growths)?
*
Have you ever been diagnosed with a fatty liver?
*
Do you have elevated triglycerides?
*
3
6
9
